Splenomegaly is massive enlargement of the spleen, which makes the spleen palpable under the left costal arch. The goldstandard definition of splenomegaly is splenic weight. Three patients among the patients you are seeing today are the following three. Symptoms are seldom caused by the size of the spleen directly, but rather due to its hematologic effects on the different cell lines, which manifest as anemia, leucopenia, thrombocytopenia, or as a combination of these i. Any ectopic tissue such as accessory spleens would also be hypertrophied. Splenomegaly is a frequent finding among hivinfected adults 1, 2. How do you differential the spleen from the kidney on abdominal examination. Anatomy develops from condensations of mesoderm in the dorsal mesogastrium. Splenomegaly symptoms, diagnosis, treatments and causes. Visit our research pages for current research about splenomegaly treatments clinical trials for splenomegaly. Acute signs such as tachypnoea, tachycardia, and hypotension characterise sepsis with splenic abscesses or splenic rupture. The nature of pain associated with splenomegaly varies with the cause of splenomegaly. In children, as a result of the thinness of the abdominal musculature, a palpable spleen is commonly encountered.
Splenomegaly is usually detected during a physical examination by a health care provider. He performed a followup study in 1978 2 and found that 4 of the 10 patients developed malignant lymphomas 8 months to 6 years after. Castells sign is a medical sign assessed to evaluate splenomegaly and typically part of an abdominal examination. Diagnosing splenomegaly involves a number of tests, including. Splenomegaly hematology and oncology merck manuals. Mistry pk, lukina e, ben turkia h, amato d, baris h, et al. The spleen usually lies in the left upper quadrant luq of the human abdomen.
Palpable spleen always indicates splenomegaly or normal spleen not. Splenomegaly increases the spleens mechanical filtering and destruction of red blood cells rbcs and often of white blood cells wbcs and platelets. Mild to moderate splenomegaly may be recorded in the bilag index but not in other indices, such as sledai and eclam. Evaluation of splenomegaly differential diagnosis of. The spleen does not normally descend below the left costal margin. The presence of pallor indicates anaemia and is a common finding associated with many of the causes of splenomegaly e. The essential companion to the diagnostic and statistical manual of mental disorders. It is an alternative physical examination maneuver to percussion over. Clinical assessment begins with a thorough history and exami nation.
Splenomegaly is an enlargement of the spleen resulting from abnormalities of its lymphoid, reticuloendothelial, or vascular components. Mri is especially useful in detecting portal or splenic vein thromboses. It can be detected on physical examination by using castells sign or traubes space. The first is an elderly woman who complains of easy fatigability, and her conjunctivae and nail beds are pale. The etiology is diverse and may result from increased splenic activity, decreased venous drainage, or infiltration of the spleen. It is an alternative physical examination maneuver to percussion over traubes space splenomegaly, although associated with numerous diseases, remains one of the more elusive physical exam findings in the abdomen. Ultrasounds show a bulging shape and rounding of the normally pointy poles. A splenic edge felt more than 2 cm below the left costal margin is abnormal. He is also a skilled bedside examiner and has wonderful tips for examining the spleen and lymph nodes. Palpation and percussion of the spleen are important techniques for identifying an enlarged. Splenomegaly is one of the four cardinal signs of hypersplenism which include. For hematological evaluation, a brief clinical history and examination were recorded, and three milliliters of venous blood was collected in edta anticoagulant. Assessing for the presence of splenomegaly is an important component of the physical examination. Dullness may indicate splenomegaly, solid gastric content, or colon content.
A perfunctory examination while assuming the spleen is not going to be palpable is the best way to miss an enlarged spleen. The spleen is enlarged in a number of important clinical diagnoses. However, little is known about the prevalence and clinical significance of this finding in asymptomatic patients. Ultrasound estimation of spleen size full text view. Superficial abdominal venous distention may be present when splenomegaly is a result of portal hypertension. This stanford medicine 25 video was created in conjunction with stanfords aim lab teaching the examination of the spleen. The exam is significant for axillary lymphadenopathy, abdominal. Patients with splenomegaly due to liver disease, malarial parasites on thick or thin blood film, positive widal test, or positive blood cultures were excluded from study. Clinical pearl to better appreciate the spleen, have your patient lay on their right side and flex their legs towards their body. Accuracy of palpation and percussion manoeuvres in the diagnosis of splenomegaly. Assessment of splenomegaly approach bmj best practice.
Hackett graded splenomegaly in malaria based on clinical findings. Hypersplenism is a secondary process that can arise from splenomegaly of almost any cause see table common causes of splenomegaly. The history may elicit symptoms of pressure effects from the enlarged spleen, such as left. It is a reservoir for platelets and a site for the proliferation of blymphocytes. Splenomegaly medigoo health tests and free medical. This same grading scheme can be used for other disorders causing splenomegaly. Clinical approach to isolated splenomegaly1 authorstream presentation. Following abdominal examination, physical examination should focus on the following. The patient is a 7 year old boy of turkish descent who was diagnosed in russia with splenomegaly and anemia at the age of 8 months. In 1969, dacie et al 1 described 10 patients with nontropical idiopathic splenomegaly or primary hypersplenism that occurred in isolation without evidence of immune thrombocytopenic purpura, lymphadenopathy, or the b symptoms of lymphoma. Get a printable copy pdf file of the complete article 1. A detailed examination of the abdomen will probably be performed. He began having seizures, usually associated with fever, at the age of 6 months. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune system, and destroying.
It has been found in up to 70% in a postmortem study. Population for whom the physical examination of splenomegaly should be sought. Case 478 a 7 year old boy with massive splenomegaly upmc. It is difficult to create a stepwise algorithmic approach to the patient with splenomegaly. Although splenomegaly is often considered to be an ominous clinical finding, certain normal variants have been found. Splenomegaly american academy of pediatrics textbook of.
Common splenomegaly exam questions for medical finals, osces and mrcp paces. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems. An ultrasound examination confirmed the splenomegaly with slight enlargement of the liver but which did not meet criteria for hepatomegaly. You suspect that she is anemic due to gastrointestinal blood loss, but among your differential diagnoses you consider a lymphoproliferative disorder and decide to examine her for splenomegaly. Effect of oral eliglustat on splenomegaly in patients with gaucher disease type 1. Clinical examination of spleen jibran mohsin resident, surgical unit i sims services. Blood tests such as a cbc tests for suspected causes abdominal film or ct scan. Examination of the spleen is also one of the core competencies that the investigators expect our students and residents to learn as part of. Prevalence and clinical significance of splenomegaly in. References evidencebased clinical decision support at. Splenomegaly can be found in 3% of the normal population. Splenomegaly definition of splenomegaly by medical. These continued every two to four months until the age of five.
Grades for splenomegaly based on clinical examination. Spleen exam stanford medicine 25 stanford medicine. Changing the doctor through time medical history physicianpatient relationship method of medical thinking oriented system trouble list pain fever. Splenomegaly, enlargement of the spleen, the abdominal organ that serves as a temporary storage site for blood and filters out degenerated and old blood cells. Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. The parents said that they were told that a urine test was abnormal but that they had to wait for more testing and had a followup appointment in 2 weeks. Clinical examination of spleen linkedin slideshare. Splenomegaly is a common finding on clinical examination, and frequently features in postgraduate assessments. Patients were initially evaluated with clinical history, microscopic examination of blood smear, and blood counts. Examination of the spleen stanford medicine 25 youtube. Splenomegaly may arise as a symptom of a number of diseases, including certain systemic infections, inflammatory diseases, hematologic diseases, inherited spleen disorders, cysts, and neoplastic diseases. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. Ct and mri may provide more detail of the organs consistency. Splenomegaly causes of splenomegaly portal hypertension 33% chronic liver disease portalsplenic venous obstruction.
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